Saliva supports eating and talking, flowing from the salivary glands of the mouth. Viruses, infections, and chemical changes to the makeup of saliva can lead to sialolithiasis, crystallized stones blocking the salivary ducts. Reduced saliva flow can also result in stone formation. Medications which cause “dry mouth” such as antihistamines or psychiatric drugs can have this effect. Dehydration from reduced fluid intake, sweating, or diarrhea can occur also. Limited eating can result in a reduction of saliva flow as well. Treatment to remove or dissolve stones should be accompanied by changes in the factors which may have led to them.
Symptom: Pain and Swelling
Face, neck, and mouth pain can indicate stones and possibly an associated infection. The pain and swelling will become worse as saliva flows in response to mealtime and is blocked by one or more stones. Swelling and tenderness near any of the three sets of salivary ducts particularly the lower set, trouble swallowing, and difficult jaw movement can be indications of stones as well. Pain in the face, neck, and mouth can have many origins including dental problems, nerve issues, and bone conditions. If salivary stones are not the source of the pain, further diagnosis is necessary.
Blocked saliva flow can lead to an infection. The infection is noticeable by a foul smell or taste, fever, and redness or tenderness in the gland area. While home remedies can help clear some stone blockages if an infection is evident, a doctor or dentist visit is in order to consider antibiotic treatment in addition to stone removal. Infection should be addressed promptly to avoid the spread of bacteria in the face and mouth.
The most common location for salivary duct stones is at the exit of the submandibular glands. This is in the back of the mouth by the sides of the jaw. The parotid glands, on both sides of the face forward of the ears, tend to have smaller stones. Multiple stones do occur in about a quarter of cases. Check for reddening of the gland and duct areas with light pressure. An observation of reduced saliva flow in the mouth can help identify the location of any stone blockage.
Diagnosis of sialolithiasis is performed by a doctor or dentist. They look for swelling of the salivary glands and evidence of the stones. Imaging such as an x-ray, CT scan, or ultrasound can help pinpoint the stones. And potentially identify any additional ones which are not yet symptomatic. As the medical professional identifies the source of the stones, he or she can help identify long-term solutions. They will also look for any structural problems with the salivary glands and ducts which need to be addressed to avoid recurring stone problems.
Some home remedies can help eliminate stones. Though patients should be careful not to use them for recurring cases without a medical consult. Enhancing hydration by drinking more water and sucking on sugar-free sour candy to stimulate saliva flow can release stones. Warmth and gentle rubbing of the duct area can also help. If the stone leaves the duct and saliva begins flowing, note any foul taste or smell for evidence that an infection was developing. Consider mouth rinses to keep the area clean as it heals.
Medical Treatment: Removal of Whole Stones
The doctor or dentist may push carefully on the duct sides to eject the stone. This will only work with smaller stones, and larger stones may require surgical removal. Surgery is also an option in some cases to remove glands which have had repeat problems. This leaves the remaining glands to provide saliva which is usually enough.
Medical Treatment: Lithotripsy
Sound waves such as those used to break up kidney stones can help to reduce the salivary duct stone. This is known as lithotripsy. Once the stones are fractured, the resulting pieces of the stones can then exit the duct with the saliva flow. This eliminates the need for surgery. The patient is sedated for this technique, which is similar to a dental procedure.
Medical Treatment: Surgery
If surgery is considered for a large stone or difficult infection, the stone will be removed. And the entire gland may be removed as well. This should be a complete and long-term solution, but it is not without risks. The facial area contains nerves essential for facial expressions and other head and neck functions. Saliva production, however, should still be sufficient after a single gland is removed.
Medical Treatment: Sialendoscopy
Sialendoscopy is a newer technique for removing salivary duct stones. This is somewhat like a smaller version of laparoscopic surgery. It uses a tiny lighted scope and micro instruments to find and remove the stone from the duct opening. As with sound wave lithotripsy, the patient is sedated or lightly anesthetized for this procedure and returns home the same day. These two techniques may help avoid surgical removal of larger stones, as long as the gland and duct remain undamaged by infection or other factors.
Medical Treatment: Infection Management
Removal of salivary duct stones which have been in place for some time may involve addressing a bacterial infection which has developed in the pooled saliva. Saliva flow will keep the duct healthy. Antibiotics will address the localized infection as well as any expansion of the infected area throughout the face and mouth. The doctor or dentist will consider appropriate antibiotic use when indicated.